{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:00:14Z","timestamp":1790787614131,"version":"4.1.0"},"reference-count":21,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,3,15]],"date-time":"2025-03-15T00:00:00Z","timestamp":1741996800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Occult lesions involving the facial nerve can be misdiagnosed as idiopathic facial paralysis, also known as Bell's palsy. Our goal was to compare the clinical features of patients with idiopathic\/viral versus non\u2010idiopathic facial paralysis and identify predictors of malignant etiologies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective chart review of 276 patients referred for surgical management of facial paralysis at two large facial nerve tertiary care centers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 176 patients had idiopathic\/viral facial paralysis (IFP) and 60 patients had non\u2010idiopathic facial paralysis (non\u2010IFP), including malignancies (50\/60), benign neoplasms\/nerve sheath tumors (8\/60), and systemic\/CNS disorders (2\/60). Non\u2010IFP was more likely to be characterized by gradual onset (57.4% vs. 10.3%; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), progressive course (65.0% vs. 19.8%; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), irreversible flaccid paralysis (41.7% vs. 10.4%; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), and lack of response to medication therapy (71.4% vs. 28.7%; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). A past medical history of skin cancer or pre\u2010cancerous lesions (36.4% vs. 7.26%; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) and salivary gland cancer (23.3% vs. 0.57%; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) were also associated with non\u2010IFP. Epiphora\/tearing, facial pain, and facial numbness were associated with malignant FP. 14\/60 (23%) patients with non\u2010IFP experienced a diagnostic delay of greater than 6\u2009months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Facial paralysis that is gradual onset (&gt;\u200972\u2009h), progressive, without synkinesis, and unresponsive to medications should be further evaluated for nonidiopathic causes. Malignant lesions may be associated with other symptoms such as facial pain, facial numbness, and epiphora\/tearing. Also consider malignant causes of FP in patients with a history of skin or salivary gland cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>3.<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.32112","type":"journal-article","created":{"date-parts":[[2025,3,15]],"date-time":"2025-03-15T08:37:46Z","timestamp":1742027866000},"page":"2882-2888","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["A Multi\u2010Institutional Review of Characteristics of Idiopathic Versus Non\u2010Idiopathic Facial Paralysis"],"prefix":"10.1002","volume":"135","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2443-3583","authenticated-orcid":false,"given":"Shreya","family":"Mandava","sequence":"first","affiliation":[{"name":"University of Virginia School of Medicine  Charlottesville Virginia USA"},{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Gossett","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Wake Forest University  Winston\u2010Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil P.","family":"Monaghan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0664-4571","authenticated-orcid":false,"given":"Shaun A.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishna","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Oyer","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of Virginia  Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,15]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2020.35.e245"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24542"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0030-6665(20)32845-0"},{"key":"e_1_2_6_5_1","unstructured":"N. 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